Chemotherapy requirements

I wonder if someone could give some advice (any would help). My sister was diagnosed with invasive breast cancer. Her tumor was 2.2 cm. She had a mastectomy and her pathology results were as follows:

margins clear
3 of 18 nodes positive for metastize. 1 of the nodes was the sentinal node which was done earlier to see if it had spread to the nodes.
When they did the mastectomy they removed another 17 nodes and two were positive, both tumor deposit measured 5 ml.
No extracapsular identified
The nodes did not seem to be matted or saturated
Her2 neg
Estrogen positive 2 out of 3
Her score is 5-9 Grade 1 cancer

She has had a bone scan it was fine. She had a liver ultrasound and it showed some polyps, but doctor did not seem to be concerned. A ct scan of the liver will be taking place just to make sure.

She has stage 2B breast cancer. She feels great and does not want to proceed with chemo, which is scaring the heck out of me. Someone had mentioned that in the States, chemo is only administered when there are 4 or more nodes positive. Here in Canada, they treat it more aggressive in that they administer chemo if only one node is positive. Her margins are clear. What are her chances of recurrence if she does not have the Chemo? Are her results that bad?

American guidelines formulated by the National Comprehensive Cancer Network (nccn.org) state that for ER positive, HER2 negative tumors, adjuvant chemotherapy must be considered if tumor is > 1 cm, or if tumor is 0.6 cm to 1 cm and has lymphovascular invasion or grade 2-3 features.

European guidelines formulated at the St Gallens Conference state that for ER positive, HER2 negative tumors, consider chemotherapy of tumor is > 2 cm, or Grade 2-3, or age is < 35, or lymphovascular invasion is present.

Based strictly on size criteria, both American and European guidelines recommend chemotherapy, as your sister had a 2.2 cm tumor.

American guidelines strictly call for chemo in case of node positivity, and European guidelines if number of positive nodes are 4 or more.

Hence, it would benefit her to have chemotherapy. There are many clinical trials evaluating "gene signatures" that aim to predict more accurately which women would benefit from chemotherapy. The objective is to prevent unnecessary toxicity of chemotherapy to women who would not benefit from these drugs.

She has many prognostic features which are favourable. Grade 1, ER positive, HER2 Negative, absence of extracapsular spread are all good features.

Thank you ever so much for your very valuable information. I will pass it on to my sister. We have both had a rough year as we were both diagnosed back to back in the Spring of this year. First mammograms for both. I had a double mastectomy and was extremely blessed that no further treatment is required for me. My sister on the other hand is dealing with the above and I am trying to help her through it. So the information you provided is extremely helpful.

Again, thank you so much for the valuable information that you provided for my sister regarding the Chemo. My sister does not see an oncologist until next week, and we are having a hard time with her. I am just curious, based on her results as noted above - if she does not have the Chemo, will the cancer return for sure? or is Chemo just a precaution so that the cancer does not return?

I am sorry to be a bother and appreciate any further help or info that you can provide.

Hi Tina,
Treatment for early breast cancer generally involve local therapies like surgery and radiation as well as systemic therapies like chemo, hormones, monoclonal antibodies etc.
Local therapies remove all visible cancer, while systemic therapies attack and hopefully kill all invisible cancer cells ("micrometastases") at distant sites.
It has been clearly shown in clinical trials that adding adjuvant chemotherapy reduces the chances of cancer recurrence.
Best,
Dr Saini

I was diagnosed with invasive breast cancer in May 2009. I am T2 N1 M0. I was told I was HER2 Negative. I was also told the tumor was Estrogen positive. I had 7 nodes removed and only 1 was posistive. I had all the test done on my body and they are all clean.
My question is about Chemotherapy. I am on TAC and have had 2 treatments. I am very sesitive to the drugs and have been sick for 14 days or longer after each treatment--even with the use of nausea drugs. I was wondering what you think about taking 3 full treatments and for the last 3 do half treatments.
Thanks for taking time to answer me.
Mary

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